Impact of Decreased Estimated Glomerular Filtration Rate on Japanese Acute Stroke and Its Subtype

Chinda, Junko; Nakagawa, Naoki; Kabara, Maki; Matsuki, Motoki; Endo, Hisako; Saito, Tsukasa; Sawada, Jun; Katayama, Takayuki; Sato, Nobuyuki; Hasebe, Naoyuki

doi:10.2169/internalmedicine.51.7185

Cited by 28 publications

(28 citation statements)

References 22 publications

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“…Prevalence rates of renal dysfunction (RD) in patients with ischemic stroke range from 23.9% up to 51.3% [1,2,3,4,5,6,7,8,9], hence, considerably exceeding age-dependent rates in the general population (8-16%) [10,11,12]. Evidence not only suggests that RD is an independent risk factor for cardiovascular events, including stroke and myocardial infarction [13,14,15], but also indicates that RD is associated with worse functional and clinical outcome in ischemic stroke patients [4,16].…”

Section: Introductionmentioning

confidence: 99%

Influence of Renal Function on Treatment Results after Stroke Thrombectomy

Laible

Möhlenbruch²,

Pfaff³

et al. 2017

Cerebrovasc Dis

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Background: Renal dysfunction (RD) may be associated with poor outcome in ischemic stroke patients treated with mechanical thrombectomy (MT), but data concerning this important and emerging comorbidity do not exist so far. Here, we investigated the influence of RD on postprocedural intracerebral hemorrhage (ICH), clinical outcome, and mortality in a large prospectively collected cohort of acute ischemic stroke patients treated with MT. Methods: Consecutive patients with anterior-circulation stroke treated with MT between October 2010 and January 2016 were included. RD was defined as glomerular filtration rate (GFR) <60 mL/min/1.73 m². In a prospective database, clinical characteristics were recorded and brain images were analyzed for the presence of ICH after treatment in all patients. Clinical outcome was assessed by the modified Rankin Scale (mRS) after 3 months. To evaluate associations between clinical factors and outcomes uni- and multivariate regression analyses were conducted. Results: In total, 505 patients fulfilled all inclusion criteria (female: 49.7%, mean age: 71.0 years). RD at admission was present in 20.2%. RD patients were older and had cardiovascular risk factors more often. Multivariate regression analysis after adjustment for age, stroke severity, diabetes, hypertension, GFR, previous stroke, MT alone, or additional thrombolysis and recanalization results revealed that lower GFR was not independently associated with poor outcome (mRS 3-6; OR 1.13, 95% CI 0.99-1.28; p = 0.072) or ICH. However, lower GFR at admission was associated with a higher risk of mortality (OR 1.15, 95% CI 1.01-1.31; p = 0.038). Compared to admission, GFR values were higher at discharge (mean: 77.9 vs. 80.8 mL/min/1.73 m²; p = 0.046). Conclusions: We did not find evidence for an association of lower GFR with an increased risk of poor outcome and ICH, but lower GFR was a determinant of 90-day mortality after endovascular stroke treatment. Our findings encourage also performing MT in this relevant subgroup of acute ischemic stroke patients.

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Section: Introductionmentioning

confidence: 99%

Influence of Renal Function on Treatment Results after Stroke Thrombectomy

Laible

Möhlenbruch²,

Pfaff³

et al. 2017

Cerebrovasc Dis

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“…Chronic kidney disease (CKD) is now an accepted risk factor for cardiovascular diseases, stroke and dementia and is a surrogate marker for adverse clinical outcomes in patients with stroke [1,2,3,4,5,6,7]. Patients with CKD are known to have endothelial dysfunction and are at risk from both thrombotic and hemorrhagic events [5,6,7,8,9,10].…”

Section: Introductionmentioning

confidence: 99%

“…Although CKD is closely associated with cerebral SVD, the association between CKD and clinical outcomes in patients with RSSI has not yet been clarified. Several studies have assessed CKD in cohorts of patients with stroke [3,4,6,7,15], in cohorts of patients with ischemic stroke [5,9,11] and in the general population [1,2,10,12,13,16]. Moreover, it is unclear as to whether or not CKD affects the longitudinal clinical outcomes of patients with RSSI.…”

Section: Introductionmentioning

confidence: 99%

Chronic Kidney Disease Is an Independent Predictor of Adverse Clinical Outcomes in Patients with Recent Small Subcortical Infarcts

Saji

Sato

Sakuta

et al. 2014

Cerebrovasc Dis Extra

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Background: Chronic kidney disease (CKD) is associated with cerebral small vessel diseases (SVD) and predicts stroke, cardiovascular events and mortality. However, its association with recent small subcortical infarcts (RSSI), a novel subtype of cerebral SVD, has not yet been established in stroke patients. The aim of this longitudinal study was to clarify whether CKD can predict clinical outcome in patients with RSSI. Methods: We enrolled patients with first-ever RSSI (formerly categorized as acute lacunar stroke). CKD was defined as an estimated glomerular filtration rate of <60 ml/min/1.73 m² on admission. The patients were divided into two groups according to the presence or absence of CKD. The endpoints were recurrent stroke, cardiovascular events or all-cause mortality. The patients were followed up at 3, 6 and 12 months after stroke onset and yearly thereafter. Event-free survival analysis was undertaken using Kaplan-Meier plots and the log-rank test. Cox's proportional-hazards analysis was conducted regarding age, sex and the presence of any cerebral SVD. Results: A total of 152 patients (66% males; mean age: 67.6 years) were consecutively enrolled, and 44 (29%) had CKD. During the follow-up period (median: 3 years; interquartile range: 1-4), 27 patients (18%) reached endpoints. The numbers of patients per endpoint were as follows: all-cause mortality 14, ischemic stroke 9, hemorrhagic stroke 2 and aortic dissection 2. Patients with CKD were significantly older (77 vs. 64 years; p < 0.001), had higher serum creatinine (0.96 vs. 0.65 mg/dl; p < 0.001), higher brain natriuretic peptide (51.1 vs. 18.5 pg/ml; p < 0.001) and a higher National Institutes of Health Stroke Scale score on admission (3 vs. 2; p < 0.001), and were less likely to have modified Rankin Scale scores of 0-2 after stroke onset (52 vs. 77%; p = 0.003). Patients with white matter hyperintensity [odds ratio (OR) 3.0; 95% confidence interval (CI): 1.5-6.2; p = 0.003] and those with microbleeds (OR 2.5; 95% CI: 1.2-5.1; p = 0.015) had more pronounced CKD than the remaining patients. A Kaplan-Meier curve analysis showed that patients with CKD had a less favorable outcome than those without CKD (p < 0.001). The multivariate Cox proportional-hazards analysis revealed that CKD was associated with recurrent stroke, cardiovascular events or all-cause mortality (hazard ratio 2.22; 95% CI: 1.12-4.25; p = 0.02). Conclusions: CKD was found to be independently associated with recurrent stroke, cardiovascular events or all-cause mortality in patients with RSSI.

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“…We subdivided patients with AF according to cognitive status: without CI (SBT score 0-4), moderate CI (SBT score 5-9), and severe CI (SBT score [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. In these subsets of the population, we analyzed the available information on socio-demographic and clinical characteristics; length of hospital stay; in-hospital and 3-month mortality rates; and antithrombotic therapy at admission, discharge, and at 3-month followup.…”

Section: Cognitive Status and Anticoagulant Therapymentioning

confidence: 99%

“…On the other hand, it is well known that chronic kidney disease (CKD) patients are at higher risk for ischemic stroke/cardiogenic cerebral embolism, with the risk increasing parallel to the fall in estimated glomerular filtration rate (eGFR) [12][13][14]. CKD is, in fact, an important predictor of stroke among patients with non-valvular AF [15,16].…”

Section: Introductionmentioning

confidence: 99%